School of Clinical Medicine (ETDs)

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A Phenomenographic study of Clinician Educators' conceptions of clinical medical students' vocational habitus
(University of the Witwatersrand, Johannesburg, 2024) Bocchino, Loredana
Background: Many medical educators have expressed concern about producing the ‘right kind of doctor’, noting that students’ professional identities are not always aligned with societal and professional expectations. The concept of habitus, whilst similar to identity, offers a more complex understanding of the process of ‘becoming’ inherent in vocational training, in that it can both shape students’ educational experiences as well as be shaped by them. There is currently little literature addressing clinicians’ perceptions or experiences of medical students’ vocational habitus. Methods: To explore the ways clinician educators understand clinical medical students’ vocational habitus, a phenomenographic study was undertaken in which fourteen semi- structured interviews were conducted with clinician educators from various clinical departments. Findings: Four conceptions of student vocational habitus were identified: 1) the Dependent Spectator, 2) the Interested Fledgling, 3) the Independent Contributor, and 4) the Interdependent Altruist. Conceptions were characterised by seven dimensions of variation: attitude to learning, communication skills, fortitude, values, professionalism, technical competence and relationship to technology. Two associated factors in the field were repeatedly reported that provide important context for the interpretation and development of these conceptions: failure to fail, and fitness for purpose of assessments. Conclusion: Different conceptions exist about clinical medical student vocational habitus, with the narrowest conceptions viewing students as ‘not right for the job’. There is dissonance between clinicians’ general perceptions of students’ habitus, and the idealised expectation. The progressive development of these conceptions along the continuum is likely shaped by the identified associated factors within the field, and other potential factors such as program characteristics, the hidden curriculum, or focus on research versus clinical service delivery.
A survey of current practice in anaesthesia for caesarean delivery in a Department of Anaesthesiology
(2024) Watermeyer, Benjamin David
South Africa has an increasing caesarean delivery (CD) rate and as such anaesthesia for CD has become a fundamental skill for all levels of anaesthetists. The Essential Steps in the Management of Obstetric Emergencies (ESMOE) guidelines provide a framework for practitioners with specific focus on dosage in neuraxial anaesthesia, perioperative fluids and management of hypotension. Aims The aim of this study was to describe the current practices of anaesthesia for patients requiring CD, including the management practices of common complications, within the University of the Witwatersrand Department of Anaesthesiology. Methods: A prospective, contextual and descriptive study design was followed using an anonymous, self-administered online questionnaire. Descriptive statistics were used to assess adherence to guidelines and comparison made between senior and junior anaesthetist’s practices. Results: Junior anaesthetists performed significantly more CD anaesthetics per month and had more training in ESMOE guidelines compared to senior anaesthetists. Senior anaesthetists were more likely to use a higher dose of bupivacaine. Phenylephrine as a first line anti-hypotensive agent was used by 99.4% of participants. The considered safe minimum platelet count for spinal anaesthesia was 75 x 10^9/l by 61.3% of participants. A significant difference between junior and senior anaesthetists was found where senior anaesthetists were more likely to accept a lower platelet count. A sensory level post administration of spinal anaesthetic was assessed by all participants with 53.1% using an ice brick and 35.0% requesting the surgeon to pinch the patient. Conclusion: In the Witwatersrand Department of Anaesthesiology anaesthetists do follow the ESMOE guidelines of clinical practice for CD. While there are some differences in practice approaches, these were found to be within internationally accepted practice. There would be a benefit of improved awareness of the ESMOE guidelines within the department as well as further training on the different approaches to CD anaesthesia.
Adequacy of availability of antidotes for common and critical drug poisonings and doctors’ perspectives thereof: a study in teaching hospitals in the Southern Gauteng City-Region
(2024) Fitchett, Margaret Penelope
Background: Drug poisoning is an important area of study in South Africa (SA) as a treatable cause of mortality. While research has been conducted on poisoning, there is a paucity of literature on the availability of antidotes in SA. Objectives: To assess the availability of antidotes in selected teaching hospitals in the Southern Gauteng City-Region and to explore doctors’ experiences of antidote supply. Methods: A data sheet assessing the availability of antidotes in the Emergency Departments (EDs) and pharmacies was completed in person at each of the teaching hospitals. A questionnaire exploring experiences of antidote supply was distributed to 126 doctors working in the EDs. Results: N-acetylcysteine, atropine, diazepam, clonazepam, sodium bicarbonate, vitamin K, calcium gluconate, naloxone, ethanol and pyridoxine were present in all EDs. Doctors reported organophosphate poisoning and paracetamol overdose as the most common drug poisonings (81.7% and 14.3% of 126 respondents respectively). Most doctors experienced no supply issues for N-acetylcysteine, calcium gluconate, sodium bicarbonate or pyridoxine (85.7%, 83.3%, 87.3% and 75.4% of 126 respondents respectively). Conclusion: The antidotes to the most common poisonings reported by doctors were present in all EDs. However, concerns were raised about consistency of supply which will be an important avenue for further research.
Registrars’ perspectives towards virtual teaching in an academic department during the COVID-19 pandemic
(University of the Witwatersrand, Johannesburg, 2022) Mpemnyama, Lerato Nomonde
Background The COVID-19 pandemic brought about unprecedented times that resulted in measures of social distancing that had to be put in place. The Department of Anaesthesiology at the University of Witwatersrand had to comply with these regulations and switched the teaching of registrars from in-person format to a virtual platform. The study aimed to look at the perceptions registrars had towards virtual teaching during the COVID-19 pandemic. Methods This cross-sectional quantitative study was conducted in the Department of Anaesthesiology at the University of Witwatersrand via an online self-administered questionnaire that was distributed to the registrars registered in the department. The validated questionnaire that was used was developed following a literature search and an adaptation from two validated questionnaires. The study was conducted from December 2021 to February 2022. Results The department has a total of 100 registrars, and the response rate was 90%. The study highlighted that virtual teaching did have a positive impact in teaching in the academic department, with 91% (n=81) finding virtual teaching to be effective and 63.9% (n=53) of respondents preferring virtual teaching over in-person teaching. Conclusion The COVID-19 pandemic brought about a disruption to the academic programme in the Department of Anaesthesiology at the University of Witwatersrand, resulting in virtual teaching being implemented. This move has been met with a positive response among the registrars in the department.
Students’ perceptions of the medical curriculum at the University of Limpopo
(2024) Mamashela, Thakadu Arnold
Any educational program follows a process of development by various stakeholders. Program evaluation is an important step in curriculum development and implementation. This study evaluated the medical curriculum delivery from the perspective of the students at the new medical school of the University of Limpopo. The research employed a cross-sectional descriptive quantitative method using a survey. All students registered for the medical curriculum in their second to fifth years of study were invited to participate in the research. The findings of this research showed there was a perception of factual overload in some modules, however, most of the modules were perceived to have been well taught with mixed methods of assessment strategies applied across the year levels of study. The infrastructure and the equipment required for teaching and learning activities were not considered satisfactory. Students embraced the use of technology in teaching and learning. The university provided adequate support in relation to WiFi on campus. Recommendations for teaching/ practice and future research were made.
Symbolic access: medical students’ awareness of institutional culture and its influence on learning
(2024) Lulua, Dina-Ruth
Abstract Background: The discussion of access in medical education commonly has its focus on physical and epistemological access, leaving a qualitative gap regarding sociocultural factors which influence access in this context. This study introduces and defines symbolic access, a concept with a specific lens on sociocultural inclusion, and the impact it has on student learning within a South African medical school. Methods: A phenomenographic design was used to explore conceptions of symbolic access and its impact on learning. Fifteen one-on-one exploratory interviews were conducted with final year medical students, a sample exposed to the entire 6-year medical programme. Interviews were analysed using Sjöström and Dahlgren‘s seven-step phenomenography model. Results: Four categories of description were induced, describing students’ understanding of symbolic access, these were rejection, disregard, alienation and actualization. Five dimensions of variation were discovered, and they expressed the different ways the conceptions were experienced, these dimensions were: interactions with educators, peer relationships, educational environment, race and hierarchy. Categories of description and dimensions of variation formed the Outcome Space, a visual representation of the student experience of symbolic access. The outcome space had a double narrative related to symbolic access; exclusion (major) and actualization (minor). Medical student’s chief experience within the medical community was exclusion, however experiences of peer-relationships, clinical skills lessons and participation within the clinical setting facilitated feelings of community inclusion and impacted learning. Conclusion: Despite exclusionary experiences, students articulated an awareness of attaining symbolic access during the clinical years, additionally meaningful and transformative learning experiences were described during these same years. The study found that attainment of symbolic access and students’ perceptions of valuable learning are linked. Health profession educationalists should design undergraduate curricula with early clinical immersion at the fore and explore symbolic concepts pertaining to access, as they are connected to meaningful learning experiences for the medical student.

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